ED Providers: FDA Approves Peramivir (Rapivab) for Influenza


Submitted by Steven Gamburg, MD, Chair, Emergency Medicine


The FDA recently approved Peramivir (Rapivab) which is another neuraminidase inhibitor like Tamiflu.


  • Note the indication: acute uncomplicated influenza.
  • It is administered i.v. for adults with flu duration of less than 48 hours, in a single dose. 
  • (Cost of Tamiflu ~ $120; cost of Peramivir is estimated at $950)
  • Peramivir is non-formulary at MLH. ID would be the only group of physicians that could approve writing for this medication.


HOWEVER, in discussion with Dr Ingerman, please note MLH’s recommendation for first line use of a neuraminidase inhibitor is still Tamiflu p.o. or via NG tube.


Both Tamiflu and Rapivab have similar side effects, some of which include: nausea, diarrhea, anaphlaxis, delerium, Stevens Johnson


For serious flu and hospital admission, please consult ID.


It does not seem like there is a clear advantage for the use of an expensive medication such as Rapivab for uncomplicated flu.  This is a new med with a new and limited indication and its efficacy is as limited as Tamiflu. (Shortens disease about a day, perhaps decreases serious complications such as pneumonia).


For more information, see http://www.medscape.com/viewarticle/837028


Comments welcome.


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